Deadline Extended: COB December 11

Dear Colleague:

According to the Centers for Disease Control (CDC), antibiotic resistance is one of the biggest public health challenges of our time. Each year in the U.S., at least 2 million people get an antibiotic-resistant infection, and at least 23,000 people die.
Encouraging the appropriate use of antibiotics is critical to reduce adverse health effects, prevent the emergence of resistance, and optimize the effectiveness of treatments.

The problem of antibiotic resistance is particularly concerning in our nations’s approximately 15,000 long-term care (LTC) facilities that care for an estimated 1.7 million of our most vulnerable Americans. Antibiotics are among the most commonly prescribed
medications in these facilities, and research has shown that 40% to 70% of these drugs are unnecessary or incorrectly prescribed. Because nursing home patients often have complex medical needs, antibiotic resistance leaves them at a higher risk of health complications
and death.

In 2016, the Centers for Medicare and Medicaid Services (CMS) released a final rule that required nursing homes to have an antibiotic stewardship program. However, enforcement of this rule was delayed for 18 months in November 2017 in order to educate surveyors
and providers regarding the health and safety expectations that will be evaluated through the survey process.

We invite you to join us in sending the attached letter to CMS Administrator Seema Verma, urging an update on the progress of antibiotic stewardship programs in LTC facilities that currently treat some of our most vulnerable Americans. The letter requests
a report on the progress and timeline for education trainings to be completed; plans for ensuring compliance with this rule; clarification on what standards will be used to evaluate compliance; and any incentives or penalties that will be used to promote antibiotic
stewardship program development in LTC facilities.

We believe it is critical to our vulnerable seniors that CMS move forward with the implementation and enforcement of LTC standards requiring antibiotic stewardship programs. To sign-on to this letter, please contact Alejandra Leynez atAlejandra.Leynez@mail.house.gov byCOB Tuesday, December 11 2018.

We write to you regarding the implementation of the Center for Medicare and Medicaid Services (CMS) requirement that long-term care facilities implement an antibiotic stewardship program as a condition of participation in Medicare and Medicaid reimbursement
programs.

As you know, antibiotic overuse can cause significant harm to patients, especially those in long-term care (LTC) settings. According to the CDC, antibiotics are among the most commonly prescribed medications in nursing homes, with up to 70% of long term
care residents being treated with antibiotics each year. Furthermore, the Pew Charitable Trusts Antibiotic Resistance Project points to a range of studies that estimate 40% to 70% of these drugs are prescribed incorrectly. This is particularly problematic
in nursing homes where patients often have complex medical needs. Antibiotic overuse increases the risk of adverse events such as allergic reactions or infection withClostridium difficile – a serious disease that can be deadly and is a growing threat in long-term care settings. Given that long-term care facility residents are frequently transferred to acute care facilities, those bugs can then spread into other
healthcare settings.

Antibiotic stewardship programs have been shown to improve patient outcomes and reduce health care costs by minimizing inappropriate use of antibiotics and ensuring these critical drugs are only used when necessary. To support the implementation of antibiotic
stewardship efforts in long-term care facilities, the Centers for Disease Control and Prevention developed the Core Elements of Antibiotic Stewardship for Nursing Homes in 2015 – a flexible implementation guide that outlined how these facilities can leverage
limited resources to tailor stewardship activities and protect patient safety. And in October 2016 CMS released a final rule that required nursing homes to have an antibiotic stewardship program.

However, despite the clear benefits of antibiotic stewardship efforts, many long-term care facilities still do not have these programs, often due to difficulty in designing stewardship efforts to meet unique staffing and resource needs. And although the
CMS rule was finalized in 2016, enforcement of this rule was delayed for 18 months in November 2017 in order to educate surveyors and providers to ensure they understand the health and safety expectations that will be evaluated through the survey process.

We believe it is critical that CMS move forward with the implementation and enforcement of standards requiring antibiotic stewardship programs in the approximately 15,000 LTC facilities that care for an estimated 1.7 million of our most vulnerable Americans.
Therefore we request an update on the implementation of CMS antibiotic stewardship rule in LTC facilities:

What percentage of LTC providers have been educated to date on the health and safety expectations of a stewardship program? When do you expect this education to be completed?

What percentage of surveyors have had training in evaluating compliance with the stewardship rule? When do you expect this training to be completed?

What plans does CMS have for ongoing continuing education for providers and surveyors regarding stewardship programs after the initial orientation trainings are completed?

What is the CMS timeline for ensuring compliance with this antibiotic stewardship rule?

What standards will be utilized in order to evaluate that compliance?

What incentives and/or financial penalties are being imposed to ensure compliance?

We appreciate your attention to this request, and look forward to hearing from you on the status of CMS’ efforts to implement and enforce this rule.